Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 05
This report estimates subtotals of units and fees for the number of days of overlap between each included
FSPSA record and the user-selected report period. For example, if the FSPSA record authorizes services from
01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01). Note that service authorization periods
may range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs overlapping: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2470 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Fees Avg Fee
Children Records Overlapping Overlapping Per Unit Auth
Report Period Report Period
Service Coordination, Class # 01
SCONLY-SCONLY *SERVICE COORDINATION ONLY 57 60 82.095237 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 57 60 82.095237 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 6.334323 $475.0800 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 7 7 13.000000 $975.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 11 11 14.367123 $797.3700 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 5 5 8.000000 $444.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 13 14 28.000000 $2100.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 43 43 69.088737 $5181.6500 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 6 6 9.500000 $712.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 15 15 26.005479 $1950.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 13 13 25.000000 $1875.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 54 54 81.043833 $6078.2900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 41 41 78.566667 $4360.4500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 65 65 96.098628 $5333.4800 $55.5000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 6.000000 $450.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 16 16 8.606469 $442.4700 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 0.266667 $13.7100 $51.4200
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 2 2 1.083333 $55.6900 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 37 37 17.766134 $913.3600 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 3 3 1.639497 $84.2900 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 6 6 5.111111 $262.7600 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.122222 $6.2800 $51.4000
PSTH -97163 PT EVAL HIGH COMPLEXITY 17 17 12.283255 $631.4700 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 1.246575 $64.0900 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 0.022222 $1.1400 $51.3600
SPCH -92521 EVAL OF SPEECH FLUENCY 8 9 5.048935 $259.5700 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 6 6 6.000000 $308.4600 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 40 43 17.978538 $924.2800 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.511111 $77.6900 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.4100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 2.073973 $93.0400 $44.8600
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.8600 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 8.857143 $468.8100 $52.9300
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Subtotal (Total Children Is Unduplicated) 244 447 573.133086 $36864.3000 $64.3200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 6 5.252055 $26260.5000 $5000.0400
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 32 40 41.007934 $2050.3900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 20 21 26.691269 $1334.5600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 2.000000 $50.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 331 401 616.613891 $30830.7000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 91 107 165.248409 $8262.4100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 129 145 241.021441 $12051.1200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 42 44 63.300000 $3165.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.855556 $21.3900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 99 121 166.997619 $8349.8800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 40 45 61.763491 $3088.1700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.466667 $61.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 226 260 401.438090 $20071.8800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 98 109 176.282537 $8814.1200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 4.088889 $102.2200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 8 89.714285 $4485.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 351 434 3312.271102 $165613.7100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 59 70 511.604763 $25580.2600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3 4 27.285714 $272.8600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 33 37 253.064286 $18210.5200 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 2 3 24.142857 $1737.3200 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 7.285714 $524.2800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 36 41 331.780952 $23874.9600 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 4 4 28.928571 $2081.7000 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 3.066667 $220.6800 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 21.714286 $1562.5500 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 43 46 389.016666 $27993.6700 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 13.714286 $986.8800 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 25.571429 $1840.1200 $71.9600
TRAV -TRAVS Travel by mile 2 2 58.142857 $25.8700 $0.4500
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Subtotal (Total Children Is Unduplicated) 441 1963 7072.332283 $399525.1000 $56.4900
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Total 2470 7727.560606 $436389.3900 $56.4700
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Number of Children (Unduplicated) With at Least One Authorization 528